Neuro and Pain

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction?

Sitting with the client and having a conversation

Tx for ICP?

Stop the cause! Limit activities, craniotomy

***Timing is most important during a

Stroke (CVA)

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?

Stupor

What term is used to describe a level of consciousness that sees a client responding only to vigorous and repeated stimuli and has minimal or no spontaneous movement?

Stupor

The involuntary functions of the body are controlled by these two mechanisms within ANS

Sympathetic and Parasympathetic Mechanisms

What can only be given within 3-4 hours of a CVA and can help with regaining function?

TPA

Which of the following is the lobe of the brain with functions of perception, long-term memory, and recognition of auditory stimuli?

Temporal lobe

The nurse is studying cerebral edema. Which description best explains how vasogenic brain edema occurs?

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

Hx: of TIA, atherosclerosis, hypertension, diabetes mellitus, smoking (nicotine is a vasoconstrictor), family Hx, poor diet, lack of exercise.

Risk factors for a CVA

Fight or flight?

SNS

Sweating and regulation of arteriolar blood vessel diameter are controlled by a single division of the autonomic nervous system

SNS

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by which of the following?

Second order neurons

1st Treatment for Autonomic dysreflexia?

Set the person up!

Which of the following characterizes phantom limb pain?

Severe pain after amputation

If a stroke occurs on the left side of the brain where will you see weakness?

Right

If you hand a person who has suffered a stroke a cup what would happen?

couldn't grip the coffee mug because the squeeze isn't there anymore

Shingles runs along the

dermatomes

Treatment for Complex Regional Pain Syndrome

encourage use of limbs, physical therapy, analgesics (narcotics), sympathetic block/sympathectomy, TENS, and spinal cord stimulation

Treatments for CRPS

encourage use of limbs, physical therapy, analgesics-narcotics, TENS, spinal cord stimulation, sympathetic block, choose meds that treat the transmission of pain.

Which of the following explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins.

During embryonic development, which of the following structures develops into the central nervous system (CNS)?

Neural Tube

What is the first approach to treating pain?

Non-pharmacological 1st! dimming the lights, reducing noise

Assessment of Pain ask?

OLD CARTS onset, location, duration, dull, stabbing, burning what makes it better? what makes it worse?

S/S in person experiencing a stroke?

One pupil dilated, slurred speech, *Unilateral facial drooping*, ask patient to smile

Old Carts

Onset, Location, Duration Character, alleviating/aggravating factors, radiating, timing, severity

Rest and digest?

PNS

Signs of Complex Regional Pain Syndrome

Pallor, rubor, sweating or dryness, skin atrophy

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

"Get a Zostavax vaccination.

When preventative pharmacologic treatment for migraine headaches is initiated with a beta adrenergic blocker, Which of the following statements should the patient be told?

"Take the medication as prescribed even when you are headache free."

A nurse assessing an older adult 3 hours postoperative notes guarding, grimacing, and stiff body movement when changing positions. The patient denies feeling pain. Which of the following responses will help the nurse best manage this patient's pain?

"You seem to be uncomfortable. Pain is common with surgery. I can bring you pain medication."

Damage higher than the diaphram

...

Damage to C7

...

The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the LATE stage of intracranial pressure increase?

...

referred pain

...

visceral pain

...

Medication Tx for Stroke (cva)

Plavix, Heparin, TPA, aspirin

Eptopic pregnancy burst feel pain in shoulder/ MI-nauseated, neck hurts, shoulder, arm

Referred pain

The brain receives 15% of the body's resting cardiac output and consumes ______of its oxygen.

20%

Treatment for Autonomic dysreflexia?

Remove/correct the cause, monitor VS especially BP, Promote venous pooling to decrease BP, Drugs to block the autonomic response

CVA is the ___ rd most common cause of death?

3rd

Autonomic dysreflexia usually occurs?

6 months after injury.

Normal pressure in the brain?

7-15

Long-term treatment for CVA

ACE Inhibitors, Beta Blockers, Rehabilitation

For hypertension give?

ACE inhibitors to keep angiotension from converting

Action of Opioids?

Act at the level of opiate receptors in the CNS/Drug of choice with cancer patients: alters reception of pain

The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control?

Administer the opioid preemptively and before pain becomes extreme

A patient is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by a MRI scan. Which treatment option will greatly improve his or her outcome?

Administration of IV tissue-type plasmin activator (tPA)

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure

The nurse caring for a client with an epidural hematoma recognizes that the bleeding is due to which of the following?

Aterial tear

CNS/Spinal Cord injury to T6 or higher and can cause an exaggerated sympathetic response usually 6 months after injury

Autonomic Dysreflexia/Hyperreflexia

A sore toe or full bladder can stimulate this life threatening emergency?

Autonomic dysrelexia

Intracrainal Pressure greater than 25

BRAIN DAMAGE-----no O2 to brain = tissue death

The nurse is reviewing a food diary for a client who has migraine headaches. Which foods identified by the nurse may be triggers for the onset of a migraine headache?

Beef and broccoli from the Chinese restaurant Hamburgers with bleu cheese crumbles Chocolate candy bar

When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following?

Behavioral signs of pain demonstrated by the client

What can cross the BBB and is dangerous to baby's and why?

Bilirubin---baby's bbb isn't strong. Gets stronger over time

CVA incidents are higher in?

Black men (hypertension), aging

Permits passage of essential substances from the blood to the brain while excluding transfer of unwanted materials?

Blood-brain barrier

Lovenox (Heparin) can cause?

Bruising at injection site

The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?

CT scan

Diagnostic Tests

CT, MRI

Sudden impairment of cerebral circulation?

CVA or "brain attack"

Efferent

Carries information away from effector organ. Stem of brain all about speech---saying ouch! hot

Afferent

Carries information to the CNS: tip of finger to brain----hot

Inter cranial pressure can cause?

Cerebral Vascular Incident (CVA)

The nurse is conducting a community education program on concussions. The nurse evaluates that the participants are understanding the education when they state that which of the following offers the brain protection from external forces?

Cerebral spinal fluid

The intracranial volume that is most capable of compensating for increasing intracranial pressure is which of the following?

Cerebrospinal fluid

Nerotrophic pain that effects one or more limbs formerly known as reflex sympathetic dystrophy, rare disorder of extremities characterized by autonomic and vasomotor instability.

Complex regional pain syndrome

Water-soluble substances as well as large molecules such as peptides and proteins cannot?

Cross the BBB

Highly lipid substances such as antibiotics, alcohol, nicotine, cocaine, sugar, billirubin can?

Cross the BBB with ease

The nursing assistant reports to the registered nurse that a client with a brain tumor has a blood pressure of 180/100 and a pulse of 50. Which of the following is the correct nursing intervention?

Report to physician the client's signs of increased intracranial pressure.

What needs to be done for a hemorrhagic stroke?

DO NOT GIVE anticoagulant! Surgery is needed

The nurse is caring for a trauma victim with head injury. Which factor will affect the cerebral blood flow?

Decreased Level of Oxygen

The region of the body that is supplied by a single pair of dorsal root ganglia?

Dermatomes

Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in which of the following?

Diffuse axonal injuries

The provider is testing the patient's ability to identify the specific location of skin touch in two different areas. This ability is communicated through which pathway?

Discriminative

A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?

Encephalitis

Activation of the SNS causes the release of these hormones from the Adrenal Medulla

Epinephrine and Norepinephrine

Pain assessment: wong-baker?

Faces scale

Signs and Symptoms of Autonomic dysreflexia

Flushed moist face, (pallor at first), hypertension, gooseflesh, bradycardia, baroreflx-mediated vasodilation with flushed moist skin (after).

If a stroke occurs on the right side of the brain where will you see weakness?

Left

Chronic pain is pain that lasts?

Longer than 6 months

Example of aggravating attributes to pain?

Gallbladder: eating spicy foods, fatty foods

Nutrition students are studying the nervous system, which has a high rate of metabolism. Which of the following is its major fuel source?

Glucose

The brain must have ______ to live?

Glucose and O2

A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing?

Hypoglossal

The student nurses are practicing assessment skills of various cranial nerves. Which is the name of cranial nerve XII?

Hypoglossal

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which of the following parts of the brain?

Hypothalamus

A shifting of the brain back and forth can cause?

Increased ICP

Headache, patient seems agitated, signs of?

Increased Intracrainal Pressure

Acute pain activates the fight or flight (SNS) patient will exhibit?

Increased heart rate, increased respiration's decreased GI (constipation)

Can alter bed to increase or decrease?

Intercrainal pressure

A patient's emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient. What was this patient's most likely diagnosis?

Ischemic stroke

A practitioner is preparing to do a lumbar puncture on a patient with suspected meningitis. Which of the following areas on the spine does the practitioner choose to obtain a cerebrospinal fluid (CSF) sample?

L3 and L4

Most sensitive indicator of Increased Intracrainal Pressure (ICP)

LOSS of CONSCIOUSNESS!

C5-C8

Lower cervical: upper limb muscles

L2-S1

Lower lumbar and upper sacral: lower limbs and trunk

S5-Co2

Lower sacral, coccygeal, perineal muscles, sacrum anus

S2-S4

Lower sacral: pelvis genital, gut bladder, uterus

T1-T2

Thoracic and upper lumbar: muscles, trunk, abdominal wall, all viscera lining

CVA can be caused from?

Thrombosis, embolism (associated with ischemia), Hemorrhaging-due to chronic hypertension or aneurysms.

TIA

Transient Ischemic Attack T-temporary (clears within 12-24 hours) I-impending stroke (warning sign) A-aspirin and anti-coagulant (minimizes risk of thrombosis)

True or False, Nonopioids, such as acetaminophen (Tylenol), are the first line of therapy for managing mild to moderate pain in the elderly because they are safe

True

Increased Intracrainal Pressure can be caused from?

Viruses such as meningitis Trauma--car accident Brain Tumor

Causes of Autonomic Dysreflexia/Hyperreflexia

Visceral distension: full bladder/bowel Pain receptors: ingrown toenail, dressing changes Visceral contraction: ejaculation, bladder spasms, uterine contractions

Pain is always??

WHAT A PATIENT SAYS IT IS!

Deep muschle pain

after a run, broken bone

Treatment for CVA

anticoagulant therapy, (do not give to hemorrhagic stroke) Surgical intervention Ace inhibitors TEACHING: take medications everyday decrease controllable risk factors: smoking, caffeine, salt, diet

The significant other of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should:

assess the client for additional signs/symptoms of increased intracranial pressure.

An acute episode of exaggerated sympathetic reflex response from an injury at T6 or above where CNS control of spinal reflexes is lost?

autonomic dysreflexia

FLACC scale is used to determine a number for pain in?

babies

Examples of opioids?

codeine, deloted, oxycodone, hydromorphone

FLACC Scale:

infant: face, legs, activity, cry, consolability

Raising the bed for a person with ICP?

lowers ICP pressure

Complex regional pain syndrome has two types with same symptoms but type 2 has?

major peripheral nerve injury

Complex Regional Pain Syndrome (CRPS)

no event caused the pain, neurotrophic pain, problem is not with arm or leg but the transmission...being studied still

When assessing pain always come up with a

number

No valsavers, No running, bedrest

ordered for someone with ICP

Cutaneous pain

paper cut, sunburn

without conscious control

parasympathetic mechanisms

The ______ contracts the pupil, protecting the retina from excessive light during periods when visual function is not vital to survival.

parasympathetic nervous system

Peripheral Nervous System

relaying messages, SNS--muscles, gut, viscera, bladder, uterus

Symptoms of Complex Regional Pain Syndrome

severe buring pain, incapacitating, spontaneous pain, edema, abnormalities of blood flow to skin of area, initiated by emotional upset and sympathetic nerve stimulation.

The most common cause of ischemic stroke is:

thrombis

Dorsal-posterior-afferent

travels

Ventral-anterior-efferent

travels

Trigeminal neuralgia is a condition in which patients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve what is the best treatment

trigeminal neuralgia can be controlled with carbamazepine (Tegretol)

Test cranial nerve supply for possible

tumor, impairing them

The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase?

vital signs

Emotions, sleep, libido may be affected by people

who have chronic pain

If damage to S2-S4

would lose control of bladder functioning and would need to use catheter or self catherazatn